1285795278 NPI number — HEALING PLACE FAMILY MEDICINE

Table of content: (NPI 1285795278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285795278 NPI number — HEALING PLACE FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING PLACE FAMILY MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285795278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 WREN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-851-8959
Provider Business Mailing Address Fax Number:
615-851-5949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
824 WREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODLETTSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37072-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-851-8959
Provider Business Practice Location Address Fax Number:
615-851-5949
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDERMOTT
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-851-8959

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9842836002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0102 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4147626 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: G58444 . This is a "HEALTHSPRINGS" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN01035857 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4152576 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: G20365 . This is a "HEALTHSPRINGS" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7197644 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01041710 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1790899508 . This is a "NPI RONALD MCDERMOTT M.D." identifier . This identifiers is of the category "OTHER".
  • Identifier: 6271922 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7078597 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1285795278 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3094940 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3818316 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4147623 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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